Tumour reduction and chemotherapy in ovarian cancer

The strategy of treatment for ovarian cancer has changed within recent years. Today, our aim is to resect as much tumour tissue as possible, and to treat the rapidly growing tumour residual by efficient chemotherapy. The real effect of this therapy has been assessed from a group of patients at the university hospital of Freiburg. We analysed all patients with Stage III disease who had been admitted to our hospital during a 15-year period. In the period 1984-1986, tumour tissue was reduced to a so-called optimal tumour size in 51% of all cases--in contrast to the results obtained in the period 1972-1974, when this was done in only 14% of cases. In 75% of cases, compared with 28% formerly, a partial resection of tumour was performed. It is remarkable that, at present, 37% of our patients with Stage III disease are older than 70 years. The size of the tumour residual is directly correlated with patients' survival. There is an apparent improvement in the fact that cases which are only histological cases III are more frequent today. Women subjected to more extensive surgery have less frequent postoperative mortality when compared with those who do not have extensive tumour resection. As is well known, the response of residual tumour to chemotherapy is of great importance for survival. At present, chemotherapy is started in almost 90% of cases, but it is subsequently carried through in only 77%. The differences between histologically complete remissions and primary progression are more marked than are the differences between macroscopically negative tumour residual and no tumour resection. The success of a more active form of operation must be seen in the fact that in cases where there is a small residual tumour the rate of complete remission is higher. A stronger reduction of tumour, with subsequent chemotherapy, leads to a slight improvement in the rate of cure.